Accessing Maternal Healthcare Information Using A Mobile Application
|
|
- Candace Todd
- 8 years ago
- Views:
Transcription
1 Accessing Maternal Healthcare Information Using A Mobile Application Shadrack Kioko Submitted in partial fulfilment to the requirements for the Degree of Masters of Science in Telecommunications Innovation and Development at Strathmore University Faculty of Information Technology Strathmore University Nairobi, Kenya October, 2012 This dissertation is available for Library use on the understanding that it is copyright material and that no quotation from the dissertation may e published without proper acknowledgement.
2 DECLARATION I declare that this work has not been previously submitted and approved for the award of a degree by this or any other University. To the best of my knowledge and belief, the dissertation contains no material previously published or written by another person except where due reference is made in the dissertation itself. No part of this dissertation may be reproduced without permission of the author and Strathmore University Shadrack Kioko.. Approval The dissertation of Shadrack Kioko was reviewed and approved by the following: Dr. Joseph Sevilla Faculty of Information Technology Strathmore University Dr. Reuben Marwanga Faculty of Information Technology Prof. Ruth Kiraka School of Graduate Studies i
3 ABSTRACT The ubiquity and penetration of mobile phones in Sub-Saharan Africa presents the opportunity to leverage maternal care information provision in both prenatal and postnatal cases. The slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mhealth, to address these public health priorities. Mobile health (mhealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. Being pregnant can be very challenging to mothers especially if they are expecting for the first time. In Kenya, many women rely on information that is down from one to another which may not be accurate as experience from each pregnancy can be different from one pregnancy to the other and from one person to another. Matters are made worse when information past down is mixed with cultural taboo. The aim of this research was to determine the challenges expectant women face when accessing maternal healthcare information in Kenya, to determine the current sources of the information and their limitations, determine the design requirements, the best mobile platform to develop the mobile application on and lastly to develop and test the mobile application. The findings of this research show that only a few expectant women currently access information from Internet sources. In developed countries, mobile phones are widely used to provide maternal healthcare information through mobile applications, SMS. In Kenya, few women use mobile and Internet to access this information because they rely on books, stories and doctors information which they receive rarely. The research established that mhealth has a great potential in increasing access to maternal information in developing countries. LEA, a Java based mobile application, was developed to provide maternal healthcare information to expectant women. It represents a proof of concept that mobile applications lead to sustainable prenatal and neonatal mhealth services. ii
4 Table of Contents DECLARATION.I ABSTRACT... II TABLE OF CONTENTS III LIST OF FIGURES. VI LIST OF ABBREVIATIONS.. VIII ACKNOWLEDGEMENT... IX CHAPTER 1 1 INTRODUCTION BACKGROUND PROBLEM STATEMENT RESEARCH OBJECTIVES RESEARCH QUESTIONS SCOPE AND LIMITATIONS Scope Limitations SIGNIFICANCE OF THE PROBLEM... 4 CHAPTER 2 5 LITERATURE REVIEW INTRODUCTION MATERNAL HEALTHCARE INFORMATION PROVISION MODELS AND CHALLENGES Some of the Big Issues USAGE OF MOBILE PHONES IN KENYA LEVERAGING CELL PHONES FOR MATERNAL HEALTH THE MILLENNIUM DEVELOPMENT GOALS (MDGS) MATERNAL INFORMATION PROVISION IN INDIA INTERACTIVE VOICE RESPONSE (IVR) IN MATERNAL INFORMATION DELIVERY MAMA (MOBILE ALLIANCE FOR MATERNAL ACTION) SECURITY AND PRIVACY OF INFORMATION IN MOBILE HEALTH-CARE COMMUNICATION SYSTEMS SIMILAR MOBILE APPLICATIONS My Pregnancy Today Mobile Midwife Text4Baby by Johnson and Johnson CHAPTER 3 14 RESEARCH METHODOLOGY INTRODUCTION RESEARCH DESIGN PARTICIPANTS INSTRUMENTS DATA PROCESSING AND ANALYSIS CHAPTER 4 18 DATA ANALYSIS AND INTERPRETATION OVERVIEW OF THIS CHAPTER PRE-TEST QUESTIONNAIRE Part 1: Profile Age of the Respondents Place of Residence of the Respondents Employment Status Educational Attainment of the Respondents Mobile Phone Model of the Respondents Data Capability of the Mobile Phone iii
5 Mobile Phone Technology Respondents Experience with Mobile Applications Mobile Service Provider Distribution Mobile Healthcare Applications Usage Part II: Descriptive Analysis of the Questionnaire Responses Question 1: Overall I am satisfied how I access maternal information Question 2: I have access to up-to date maternal information Question 3: I am confident to deal with any pregnancy complication that may arise Question 4: I am able to fully understand all the maternal information I receive Question 5: I have easy access to doctors, pre-natal and post-natal information care Question 6: I know where to get any maternal care information and assistance in time Question 7: It is difficult to get answers on any questions I have regarding pregnancy Question 8: If you know the proper maternal information, it is possible to avoid pregnancy complications Question 9: Mobile phone use makes it easy to access maternal information Question 10: Doctors and health workers do not really give all the maternal information when Question 11: It is expensive to access maternal healthcare information currently Question 12: I frequently use my mobile phone to access the Internet Question 13: I would prefer to access maternal information via my mobile phone Question 14: I always practice what I learn from the maternal information Question 15: its difficult to trust some sources of maternal information POST-TEST QUESTIONNAIRE ANALYSIS Level of Satisfaction in Using Mobile Application for Maternal Information Access Preferred Language of the Information Cost of Accessing Maternal Healthcare information Using Mobile Application Preferred Source of Maternal Healthcare Information CHAPTER 5 37 DESIGN AND IMPLEMENTATION ARCHITECTURE OF THE PROPOSED MOBILE APPLICATION DEVELOPMENT IMPLEMENTATION System Implementation System Specification Development Environment Client Environment WALK THROUGH THE WHOLE MOBILE APPLICATION SYSTEM Free Maternal Information How LEA IVR Works Blog Baby Due Date Calculator LEA ADMINISTRATOR BACKEND FUNCTIONALITY AND COMPATIBILITY TESTING Functional Testing Expert Usability Testing Compatibility Testing RECOVERY & SECURITY USER USABILITY TESTING QUALITY ASSURANCE CHAPTER 6 54 CONCLUSIONS AND RECOMMENDATIONS SUMMARY CONCLUSIONS CHALLENGES RECOMMENDATIONS FUTURE WORK REFERENCES 58 APPENDICES 61 iv
6 APPENDIX A: PRE TEST LIKERT SCALE QUESTIONNAIRE APPENDIX B: LIKERT SCALE PRE-TEST QUESTIONNAIRE DATA WEIGHTED MEAN AFTER THE DATA WAS COLLECTED FROM THE RESPONDENTS, THE WEIGHTED MEAN WAS CALCULATED AND INTERPRETED WITH LIKERT SCALE ANALYSIS.APPENDIX C: THE POST TEST LIKERT SCALE QUESTIONNAIRE APPENDIX C: THE POST TEST LIKERT SCALE QUESTIONNAIRE APPENDIX D: THE ADMINISTRATOR BACK END v
7 List of Figures FIGURE 1.1: MOBILE BROADBAND IN KENYA... 9 FIGURE 4.2: AGE RANGE OF THE RESPONDENTS FIGURE 4.3: RESIDENCE PLACE OF THE RESPONDENTS FIGURE 4.4: EMPLOYMENT STATUS OF THE RESPONDENTS FIGURE 4.5: EDUCATION LEVEL OF THE RESPONDENTS FIGURE 4.6: RESPONDENTS MOBILE PHONE DATA CAPABILITY FIGURE 4.7: MOBILE TECHNOLOGY OF THE RESPONDENTS' MOBILE PHONES FIGURE 4.8: EXPERIENCE OF RESPONDENTS WITH MOBILE APPLICATIONS FIGURE 4.9: MOBILE HEALTHCARE APPLICATIONS USAGE FIGURE 4.10: QUESTION FIGURE 4.11: QUESTION FIGURE 4.12: QUESTION FIGURE 4.13: QUESTION FIGURE 4.14: QUESTION FIGURE 4.15: QUESTION FIGURE 4.16: QUESTION FIGURE 4.17: QUESTION FIGURE 4.18: QUESTION FIGURE 4.19: QUESTION FIGURE 4.20: QUESTION FIGURE 4.21: QUESTION FIGURE 4.22: QUESTION FIGURE 23: QUESTION FIGURE 4.24: QUESTION FIGURE 4.25: LEVEL OF SATISFACTION IN USING MOBILE APPLICATION FIGURE 4.26: PREFERRED LANGUAGE FIGURE 4.27: COST OF DATA ACCESS FIGURE 4.28: PREFERRED SOURCE OF MATERNAL INFORMATION FIGURE 29: CLIENT-SERVER ARCHITECTURE MODEL FIGURE 5.30: SPLASH SCREEN.45 FIGURE 5.31: MAIN MENU FIGURE 5.32: INFORMATION CATEGORIES...46 FIGURE 5.33: INFORMATION CENTRE FIGURE 5.34: BLOG CENTRE 47 FIGURE 5.35: START NEW BLOG FIGURE 5.36: CALENDAR DATE SECTION...48 FIGURE 5.37: BABY DUE DATE FIGURE 5.38: HOME PAGE OF BACKEND FIGURE D.39: HOMEPAGE WITH QUICK LINKS FIGURE D.40: INFORMATION DASHBOARD FIGURE D.41: BLOG DASHBOARD vi
8 List of Tables TABLE 3.1: LIKERT SCALE QUESTIONNAIRE OF AGREEMENT TABLE 4.2 : TYPES OF MOBILE PHONES OWNED BY THE RESPONDENTS TABLE 4.3: MOBILE SERVICE PROVIDER AMONG THE RECIPIENTS TABLE 4.4: WEIGHTED MEAN OF THE RESPONSES TABLE 5.5: MAIN MENU OF LEA MOBILE APPLICATION TABLE 5.6: LEA IVR DESCRIPTION TABLE 5.7: FUNCTIONAL TESTING TABLE 5.8: USABILITY TESTING TABLE 5.9: COMPATIBILITY TESTING TABLE A.10: QUESTIONNAIRE TABLE B.11: WEIGHTED MEAN CALCULATION OF RESPONSES TABLE C.12: POST-TEST QUESTIONNAIRE vii
9 LIST OF ABBREVIATIONS CCK Communications Commission of Kenya J2ME Java Micro Edition Mobile Application or Mobile App or App This is an application developed for small low-power hand held devices that come either pre-installed on phones during manufacture or downloaded by customers from various mobile software distribution platforms. ITU International Telecommunication Union IVR Interactive Voice Response LEA Swahili word for nurturing an infant baby. LEA is the title of the mobile application NGO s Non Governmental Organizations OTA Over the Air OOAD Object Oriented Analysis and Design PC Personal Computer SMS Short Messaging System. UML Unified Modeling Language USSD Unstructured Supplementary Service Data viii
10 ACKNOWLEDGEMENT I m grateful to God for helping me make it through the entire Masters Program. I sincerely thank my supervisor Dr. Joseph Sevilla, for his guidance, feedback and keen supervision in this research. This successful completion couldn t be achieved without his invaluable support and input. I also acknowledge the feedback and ideas provided by Arnold Ogolla, Reward Wambayi, Tatiana Kioko, Edith Mutindi, James Kigen, Oscar Raywer, David Tole, Grace Mwawaza, E-Mobilis Instructors and the whole Safaricom Academy fraternity. To you all, your support is greatly appreciated. ix
11 Chapter 1 Introduction This Chapter gives a brief description of the research and is divided into 6 sections. Section 1.1 gives the background of the research, Section 1.2 details out the problem statement being tackled in the research. Section 1.3 gives the research question; significance of the study; objectives scope and limitation follow in that order. 1.1 Background Bringing a new life to the world is a wonder to everyone. Experience from each pregnancy can be different from one pregnancy to the other and from one person to another (Zantey, 2006). Matters are made worse when information past down is mixed with cultural taboos (Bronner, 2000). Healthcare information especially maternal, infant and child health are among Africa s most challenging health problems (AFIC, 2010). A mechanism is required to provide a platform for accessing healthcare information cheaply and faster. Mobile technology is very well positioned to enable this. The United Nations, Media (Paper, Television, and Radio) are doing campaigns on ways to alleviate infant deaths caused by lack of maternal information. The grim statistics are that 6,150 women die in Kenya every year from pregnancy-related complications according to UNICEF Report (2010). In the field of maternal health, mobile technology should be used to provide support during pregnancy (Eugenie et al, 2011). These systems can offer general health and health-care information to pregnant women, provide emergency-care tips and alerts, and supply post-delivery support. The same systems can also be used to offer information about emerging risks to which women are frequently exposed and remind women of the need for preventive care. The explosion of mobile networks, and the growth in handset ownership, particularly among vulnerable populations in low-resource settings, offers a revolutionary way to effectively deliver timely information to improve awareness of critical health issues and reinforce positive health behaviours. Sending this information directly to the palms of expectant and new mothers is an innovative way to empower women in low-resource settings to take action to improve their own 1
12 health and the health of their children and families. Access to information via mobile phone can mean access to information about pregnancy, childbirth and the first year of life and empower women to make healthy decisions for themselves and their families. Using technology to reach mothers directly with health information customized to their stage of pregnancy or the age of their baby is not theoretical; nearly 25 million mothers around the world receive these types of messages through the Internet; hundreds of thousands of mothers receive them on their phone. Mobile phones are able to quickly and easily disseminate information that will inform women of ways to care for themselves during pregnancy, dispel myths and misconceptions, highlight warning signs, connect women with local health services, reinforce breast feeding practices, explain the benefits of family planning, and make new mothers aware of how best to care for their babies. 1.2 Problem Statement 6,150 women die in Kenya during pregnancy and childbirth according to UNICEF (2010). Over 90% are preventable. The causes of maternal mortality are multi-faceted and deeply engrained in gender inequalities and decades of under investment in public health care. Maternal, infant and child health are among Africa s most challenging health problems. Currently expectant women rely on outdated sources of maternal information or sources that are too general to give the required information with less time, effort and cost. Most expectant women rely on information from the old pregnancy books, stories and myths while the few with who are literate and have money research from the Internet. There is a lot of information widely available in printed form but usually this information is general, too lengthy and complicated. One of the many easy and fast ways to access information is the Internet. However, the information is focused on pregnancy in western world setting. There are very few available pregnancy resources for population in developing parts of the world. Other drawbacks of getting such information is that the lack of English language proficiency and computer literacy (Infodev, 2006). Majority of expectant women are left without the crucial information yet they have access to mobile phones either Internet enabled or not. Teen pregnant girls are too shy to come out in the open and get access to information that is so crucial to them like pregnancy complications information. This 2
13 leads to the current high rates of infant and child deaths. Missing doctor s appointments is a major issue affecting career men and women who have a lot to do in the office and end up missing scheduled doctor s appointments. Mobile technology can be used to schedule these appointments and remind or alert the user once the appointment time is near. Lack of a central directory listing doctors and hospitals location and price listing deny people choice of the medication that fits their budget and is within their reach. Mobile technology can provide a look-up structure of the hospitals and doctors offices in respective locality. 1.3 Research Objectives i. To investigate the challenges expectant women face in quest for maternal healthcare information as detailed out in the problem statement above. ii. To investigate the current sources of maternal health-care information, their limitations and the need for a mobile based system to provide the information. iii. To establish the design requirements and the best mobile platform on which a mobile application for maternal health-care information can be developed on for easy access to users. iv. Develop a mobile application for providing maternal healthcare information v. Test the usability, functionality and compatibility of the mobile application with some expectant women, expert mobile programmers and medical doctors. 1.4 Research Questions i. What are the challenges that expectant women face when accessing maternal healthcare information? ii. What are the current sources of maternal information, their validity and how easy to read and understand? iii. Can a mobile application make access to maternal healthcare information easy, faster and cheaper with a wide reach? iv. What are the design requirements for the maternal healthcare information mobile application? v. How can a mobile application be developed to provide maternal healthcare information? vi. What frameworks can be used to test the mobile application? vii. Does the mobile application provide a useful resource for timely and easy access of maternal healthcare information? 3
14 1.5 Scope and Limitations Scope The research covered the limitations of current methods of disseminating maternal healthcare information such as midwifery books, Internet information and stories in terms of relevance, reliability and ease of access. Statistics on how infant deaths are attributed to lack of maternal health care information were investigated. The researcher developed a mobile application as a proof of concept that mobile phones can be used to improve access to maternal healthcare information. Also the researcher did a study on Java and Android mobile programming platforms for developing mobile applications and chose Java mobile programming platform as the best for the target users Limitations The research did not cover web based systems and other mobile programming platforms other than the one identified by the user. The researcher also did not also cover anything not related to maternal healthcare information provision, complications aside from similar applications or models designed to provide maternal information. 1.6 Significance of the Problem Information is power. Health is a universal need that forms part of Kenya's Vision 2030 (Kenya Vision 2030, 2007) and Millennium Development Goals (United Nations Millennium Summit, 2000). Access to relevant and factual healthcare information will also empower women to exercise their right to maternal health. Lack of this information hampers women s ability to partake fully in safe motherhood initiatives. Access to information is at the heart of human development and realisation of human rights. Societies and governments have it in their power to address maternal, child and infant deaths by enabling access to information. Mobile technology provides cheap, faster and secure access to information through SMS, mobile application and Interactive Voice Response (IVR). This solution develops methods mobile technology can be used to enable access to information to reduce mortality rate, improve quality of maternal health and achieve Millennium Development Goals 4 & 5. 4
15 Chapter 2 Literature Review 2.1 Introduction This chapter reviews existing models of maternal care information provision, their challenges and shortcomings, review of how mhealth models have been used in other parts of the world that can be replicated in sub-saharan Africa. Millennium Development Goals, especially goals 4 and 5 which directly affect maternal and infant issues are reviewed on how mobile applications can be used to achieve them. 2.2 Maternal Healthcare Information Provision Models and Challenges Maternal, infant and child health are among Africa s most challenging health problems (AFIC, 2010). 47% of global maternal deaths take place in Africa with the highest rate in sub-saharan countries. 85% of all maternal deaths are direct results of complications arising during pregnancy and delivery. A mechanism is required to provide a platform for mothers and other community members who form the largest part of care givers to participate in addressing common facility challenges such as chronic shortage of medicines and absenteeism occasioned by theft and mismanagement. These actions could significantly improve the health of mothers, infants and children. Half a million women die each year from pregnancy-related causes 99% being from developing countries according to the UNICEF Report (UNICEF, 2010). The risk of dying from maternal causes in Western Europe is 1 in 4,000 while in Sub Saharan Africa, it is one in sixteen. Medical experts have called for urgent action to improve maternity care for women in developing countries. The annual birth rate in Kenya is births/1,000 population as at February 19, The infant mortality rate in Kenya is 54.7 deaths/1,000 live births. These statistics show that the total national market is about 6 million, 3 million mothers and 3 million infants per year. In Kenya, estimates show that 4 million babies die at birth every year due to lack of prenatal and postnatal care, redundancy in immunisation and vaccination. In Kenya, the infant mortality rate is high at 39.4% hence action must be taken to reduce the number of deaths. Mobile Phone based Pregnancy by Support Sunway University College (2007) is a major breakthrough approach to educate women on pregnancy, monitor their own and child's progress, 5
16 follow up with medical checkups, critical updates and post delivery support through mobile phone. This will reduce the anxiety and stress among pregnant mothers. Women in rural area can benefit through this system greatly by preparing for child birth and post delivery. Studies conducted in Peru, Egypt and Uganda show use of ICT has avoided maternal deaths (Infodev, 2006). Another approach is to provide tailored information based on individual characteristics of a person. This works well for different patients who have their unique need (Bental et al, 1999). For example for pregnant mothers during each stage of pregnancy the needs may be different and different types of health attention depending upon their health and physical condition may be needed (CenterSite, 2007). Telemedicine is a generic term applied in the context of the use of information and communication technology (ICT) to deliver health services, expertise and information over a distance (Zielinski et al, 2006). One of the major benefits of telemedicine is improved access to healthcare information in underserved or neglected areas. Significantly, the cost reduces in terms of transportation for seeking consultation, speciality care and other related expenditures. Enhanced continuity of medical education is a major benefit for telemedicine in terms of competency building, and diminishing the feeling of professional isolation by dealing with health professionals in blogs, chats and other telelearning opportunities. Patients can be educated to monitor their own health. For example in (Cafazzo, 2004), diabetic patients are given device to measure blood pressure which is transmitted through mobile device to central data repository. Clinical rules engine receives the data from mobile device and notify the patients family physician if readings are not within the desired range. Mobile devices can be used to provide health information based on geographical location of the person. These mobile devices are handy to use by travellers to be aware of illness in a particular location (Kamel, 2003). In urban areas, medical advice is quite easily available through clinics where most doctors are general practitioners and expert advice is expensive. Getting medical aid and advice in rural area is difficult. To reduce infant mortality and morbidity issues, mobile phone based pregnancy support system can be an effective alternative to the Internet. This system is made possible with the rapid development of the local IT and telecommunication 6
17 East Africa has more than 120 million citizens with a large majority living in rural areas, (Sida, 2010). Almost half of its population is under the age of 15 years and about one third of the grown up population is illiterate. Mobile phones is one of the most widely available platforms for information dissemination since by 2009, there were almost 50 million mobile subscribers in the region, about 40% of the total population. Peer to peer communication i.e. voice, SMS and beeping is the killer application in this region. The number of subscribers who use their phones to access Internet is however steadily growing, which opens up for a whole range of new applications and possibilities. In Peru, a partnership between Inter-American Development Bank (IDB), Cayetano Heredia University and Movistar expanded access to prenatal care for 5,000 low-income women. This was done through Wawanet project that uses text messaging via mobile telephones to enhance the health of mothers and infants by enabling them to receive customised advice on nutrition and potential problems during pregnancy, pregnant women in (Inter-American Development Bank in Peru, 2010). This project seeks to develop a solution to the problems of maternal mortality in Peru, emphasizing that an improvement in the health of mothers and infants would also contribute to Peru s attainment of the Millennium Development Goals Some of the Big Issues i. Cost of healthcare User fees for health care push 100 million people into poverty each year and block access to skilled birth attendance for those too poor to pay (OpenIDEO, 2011) ii. iii. iv. Healthcare personnel stretched Just 1 more midwife could save the lives of 219 women. 700, 000 more Midwives are needed to achieve the Millennium Development Goal to reduce maternal deaths by 75% by Overall the World Health Organisation has estimated that over 4 million more health workers are needed around the world (OpenIDEO, 2011) General access to information and care during pregnancy and childbirth Women need more access to basic information on safe motherhood and right to decent quality healthcare based on need and not ability to pay. Information can help empower women to claim their rights and protect the health of themselves and their unborn child. Gender Inequality Women and girls have less access to education, assets and women suffer domestic violence during pregnancy in developing nations (OpenIDEO, 2011) 7
18 v. Access to education in general Women who complete primary education marry later, exercise better birth control and are more likely to use modern health services (Oxfam GB, 2001). 2.3 Usage of Mobile Phones in Kenya According to (ITU, 2009), Kenya has the third largest number of subscribers in Africa, after Nigeria and South Africa. This translates to 7% of all the mobile phone subscribers in Africa. Communications Commission of Kenya (CCK, 2011) estimates that mobile subscribers hit 22 million in September 2010 in Kenya, up from 20.1 million in June This represented a growth to 9.5 percent, the highest over the last three quarters. Notably, the number of Internet users increased to 8.69 million in September 2010 from 7.8 million users in June The arrival of the undersea fibre cables in Kenya in 2009 has revolutionized the technology and economic sectors. Kenya is one of the very few countries in Africa with a comprehensive framework set up in this regard. Average national download speeds have increased from kbps to 3, kbps in 2011 (CCK, 2011). Further, mobile broadband is the ability to access data, voice and video at high speeds over an Internet connection trough a portable modem especially a mobile phone. Recently, Safaricom and Orange announced download speeds of up to 21 mbps on their 3G networks. Network operators such as Safaricom are relying more and more on data to generate massive revenues. According to CCK (2011), mobile broadband providers are making up to 19% of their revenue from mobile data services. Subscribers are now opting to access Internet, mobile applications and other web based services on the go from their cell phones and other portable modems due to the convenience provided by a wide coverage of GSM/3G networks in Kenya. The low bundle rates being offered are also a motivating factor. 1GB of data cost about Kshs last year compared to the current rate (calculated using cheapest combinations) of Kshs Innovation is at an all-time high with many local applications for phones being produced and sold on application stores daily. Social and informative sites like Facebook, Twitter and the blogs are increasingly getting more mobile traffic than desktop traffic while marketing campaigns are slowly being taken to the mobile phone. Several incubation centres including Strathmore University ilabafrica, University of Nairobi FabLab, ihub and NaiLab have been started in Nairobi in the last 8
19 three years to nurture developers However, little attention is being given to mobile broadband services regarding mobile healthcare solutions (mhealth). The potential is huge in this sector for Kenya to achieve Millennium Development Goals (MDGs) and Vision Source: Ihub Infographic Figure 1.1: Mobile Broadband in Kenya 2.4 Leveraging Cell Phones for Maternal Health Cell phones are being used in many parts of Africa in an effort to decrease the number of maternal and infant deaths. (IRIN, 2009) has reported a drop in the number of women dying during childbirth in a village in South-central Ghana. Prior to 2008, approximately 20 women died in childbirth each year, bleeding to death while trying to get word to an ambulance service to take them to the hospital. In 2008, after phone and Internet technology were introduces to this small village in Ghana, no women died in childbirth. In this situation, Ericsson teamed with Zain, a mobile 9
20 telecommunications firm, to install Internet access and mobile phone coverage in the village in 2006, providing free handsets to health workers and selling handsets to villagers for US$10 each. While this approach was effective in this small South Central Ghanaian village, the ability to scale such an effort to all rural towns and villages in Africa is unknown, as attempts to lay broadband across the entire continent has been a slow and expensive effort happening over the last 10 years. 2.5 The Millennium Development Goals (MDGs) In 2000, world leaders set themselves a set of targets to significantly reduce poverty around the world (United Nations Millennium Summit, 2000). The MDGs, endorsed by 189 countries, are eight goals that promote poverty reduction, education, maternal health, gender equality, and aim at combating child mortality, AIDS and other diseases. The UN s 4 th and 5 th millennium development goals which state that by 2015, developing countries need to reduce child mortality rate and improve maternal health. Notably, MDG 5, to reduce maternal deaths by three quarters, is the most off-track of all the MDGs. 2.6 Maternal Information Provision in India In India, ZMQ Software Systems is developing an SMS application for women in villages to receive prenatal care (The Wall Street Journal, 2008). As this Gurgaon based mobile gaming company puts it; first, mobile phones took a stab at replacing radios, television sets and computers. Now, they ll get a shot at playing doctor, too. ZMQ develops innovative ICT solutions, software, and applications for empowering people and enabling sustainable development. They have launched a program where women in the rural areas will be able to get prenatal advice via text message. The new offering builds both on efforts to tap into the nearly 300 million mobile phone users in India and parallel attempts to use technology to get basic health care into areas that don t have it. Under ZMQ s new service, once a woman registers with her date of pregnancy, she will receive weekly tips on what to eat, what vaccines to get, and when to get check-ups. An interesting and exciting feature is that since men usually carry the phone, the company is tying up with network providers such as Reliance Communications Ltd to reward the user with one free phone call each time an expectant mother logs in. The use of mobile phones may also be a step away from the problems that plagued previous strategies to use technology in rural health care. Telemedicine projects, which used a centrally located doctor to provide advice through telephone and video conferencing with remote contacts, ran into difficulties of cost and confidence. 10
21 The company is also focused on developing innovative ICT products for new markets of the world at the Bottom-of-the-Pyramid (BOP) by successfully reaching out to grass-root, under-privileged, and marginalized communities; based on viable and self-sustaining business models in support of the social cause. The use of J2ME technology in communication has the advantage of its use in low cost cell phones which a huge percentage of the population in Kenya affords. It will help many women with information regarding their pregnancy and developing countries to achieve the UN s 4 th and 5 th millennium development goals. 2.7 Interactive Voice Response (IVR) in Maternal Information Delivery IVR is 24/7, quick and easy access to specific data without the need to speak to a customer service representative or launching a mobile app. FEP IVR provides information for and about members of the Blue Cross and Blue Shield Service Benefit Plan also known as Federal Employee Program, or FEP (Federal Employee Program, 2008). It is based in Nevada, US. The FEP IVR offers providers and facilities the opportunity to obtain eligibility, benefits, claim status, including check information and ability to request copies of remits; also Pre-certification guidelines with option to be connected to the Pre-cert area and Anthem addresses by specific state. 2.8 MAMA (Mobile Alliance for Maternal Action) The MAMA 2011 project was aimed at empowering expectant and new mothers to make healthy decisions by harnessing the power of mobile technology. Many women around the world have limited or no access to basic health information required for them to have safe pregnancies and healthy babies. These women typically live in resource-constrained settings that lack the first-line providers of such information nurses, midwives, and trained birth attendants. According to MAMA, (2011) only half of the 123 million women who give birth each year receive the antenatal, delivery, postnatal, and newborn care they need. Health information can be critically important during the period when women and their newborns are most at-risk. Each year, in the brief window of time between the onset of labor and 48 hours after birth, 150,000 women and 1.6 million give birth completely alone. Health information can increase understanding of proper nutrition for mother and baby and aid in recognition of warning signs that require clinical attention. 11
22 Over the past several years, there has been an explosion of mobile networks in developing countries. Mobile subscriber penetration has reached over 5 billion people worldwide out of a total world population of 6.9 billion and the UN estimates that by 2012, half the people living in remote areas will have one. More than 1 billion women in low and middle income countries own a mobile phone (MAMA, 2011). 2.9 Security and Privacy of Information in Mobile Health-Care Communication Systems The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of all heath care information are key factors to be considered in the transmission of medical information for use by authorised users. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. Medical information sharing to expectant women is made possible through mobile phones, due to the implementation of Internet and Intranets. But the vital issue in this method of information sharing is security: the user s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised Similar Mobile Applications My Pregnancy Today It is a daily pregnancy application that guides women, from the baby due date given, gives answers and prepares for baby's birth (Baby Center, 2011). The versions available are for smart phones iphone, ipod Touch and Android. This targets high-class and tech-savvy users who have the money to buy smart phones and pay for the data charges. My pregnancy app has other features like fetal development images these are images developed by expert medical illustrators. Pregnancy checklist is an interactive to-do list filled with activities and reminders to keep you on track with decisions, doctor appointments, and more. A nutrition guide gives the tips and recipes to help eat well and manage cravings. In this research, LEA mobile application that provides maternal healthcare information to expectant women was designed for Java enabled phones, targeting mostly low income users and those in rural areas. My pregnancy app has these functionality's similar to LEA; my pregnancy day by day weekly guide for daily information and device. Due date calculator; for users to figure out your due date and count down to the big day, similar to the one LEA has which uses the LMP method. Birth 12
23 clubs where users meet other moms-to-be who are due at the same time as you and get instant advice and support Mobile Midwife A mobile phone-based health education program for pregnant women and recent parents in Ghana sponsored by MoTeCH (Grameen, 2011). MoTeCH is a multi-part project that uses mobile technology to send pre-natal and post-natal health information to Ghanaian's and allows community health workers to collect and share health data. Women register for the program and receive either SMS or voice messages with health information. The organization designed the messages to be applicable to both men and women, as they anticipated that both partners would listen to the messages (the report found that 99% of respondents chose to receive voice messages). The messages were designed to tell women what to expect during pregnancy, dispel myths and cultural practices, and provide general health information. The design of Mobile midwife and LEA is the same but the model of delivery is different. Mobile Midwife uses SMS while LEA uses a mobile application and IVR. Ghana is similar to Kenya in that both are developing countries and face similar challenges in maternal healthcare provision Text4Baby by Johnson and Johnson (Brian, 2010) Johnson & Johnson has launched a mobile health initiative similar in aim and execution to Text4Baby for the more than 20 million expectant mothers in China, India, Mexico, Bangladesh, South Africa and Nigeria. Johnson and Johnson estimates that 1.1 billion women in those countries have a mobile phone today and are likely to sign up for its new program, Mobile Health for Mothers, which includes free mobile text messages on prenatal health, appointment reminders and phone calls from health coaches. This will have a great impact and reach to the users since all mobile phones are enabled to receive text messages; they are confidential compared to mobile applications as a way to provide maternal care information. Johnson & Johnson also launched its BabyCenter mobile campaign with mobile agency Velti in 2007, first in India (Sailesh et al, 2011). The target was young, pregnant women since PC Internet availability was very poor within its demographic. Pregnant women were invited to text their due date to a short code to join the community and receive advice on maternal information. 13
24 Chapter 3 Research Methodology 3.0 Introduction In the previous chapter, maternal care information provision in Sub Saharan Africa, the challenges and similar mobile applications for provision of maternal information are discussed. From the research objectives, parameters for designing materials, tests and questionnaire are drawn out. Chapter Three is divided into four sections. Research design provides general information about the study. The other parts participants, instruments and materials, data analysis and processing of the research are described in details. 3.1 Research Design In this research, quantitative data collection methods were used as they are centred on the quantification of relationships between variables. These quantitative data-gathering instruments established relationship between measured variables in the demographic, mobile device specifications and survey proper sections of the questionnaire used. Through the use of these methods, the researcher was detached from the study and the final output was context free. Quantitative approach is useful as it helped the researcher to prevent bias in gathering and presenting research data. Quantitative data collection procedures create epistemological postulations that reality is objective and unitary, which can only be realized by means of transcending individual perspective (Ivythesis, 2011). The quantitative data gathering methods used were very useful since the study needed to measure the cause and effect relationships evident between the existing methods of accessing maternal healthcare information and the use of a mobile application to access the same information. The purpose of the quantitative approach in this research was to avoid subjectivity by means of collecting and exploring information which describes the experience being studied. Simple random sampling was done for the sample selection. This sampling method is conducted where each member of a population has an equal opportunity to become part of the sample (Coventry University, 2005). As all members of the population have an equal chance of becoming a research participant, this is said to be the most efficient sampling procedure. In order to conduct this sampling strategy, the researcher defined the population first, listed down all the members of the population and then selected members to make the sample. For this procedure, the lottery sampling 14
25 or the fish bowl technique was employed. This method involves the selection of the sample at random from the sampling frame through the use of random number tables (Saunders et al, 2003). Numbers were assigned for each person in the master list. These numbers were written on pieces of paper and drawn from a box; the process was repeated until the sample size was reached. A research questionnaire was used for data collection since respondents are more truthful while responding to the questionnaires regarding the subject title of study in this research due to the fact that their responses are anonymous. A drawback with questionnaires is that majority of the people who receive them do not return and those who do might not be representative of the originally selected sample (Leedy and Ormrod, 2001). This research study was done in a pre-test and post-test design. After the sample population filled the first questionnaire (for pre-test purposes), LEA mobile application was installed in their phones. The users were given two weeks to use the application then they filled the post-test questionnaire. This was done to test the experience the users had using the mobile application to access maternal information, as compared to other sources of maternal information. 3.2 Participants In order to determine the challenges expectant women come across when accessing maternal healthcare information, a total of 15 respondents were asked to participate. Of the total 15 respondents, 5 from rural areas and 5 from slum areas and 5 from middle class and high class urban areas. To achieve pertinent information, certain inclusion criteria were imposed. The participants who qualified for the sample selection were currently expectant women or had already given birth, each owning a mobile phone. This qualification ensured that the participants understood the nature of the questionnaire and its use for access to maternal healthcare information, making the survey items easy for them to accomplish. The population was divided into three categories. The first category was the geographical location: urban and rural areas. Urban areas were further classified into two: slums and middle class/high class areas. The second category was literacy level: literate, semi-literate and illiterate. The third category was employment status: unemployed and employed. The assumption was sample population living in middle and high class who are literate and employed have a stable source of income leading to easy access to maternal care information from 15
26 different sources, easy access to doctors and are well educated to understand any information. Sample population in slums have low literacy levels, low income, and some are ignorant hence it is difficult for them to access maternal healthcare information, access to doctors and it is challenging for them to understand the information they receive. Sample population in rural areas have limited access to doctors and sources of updated maternal healthcare information since they have to travel to the traditional sources of this information like hospitals, clinics. This increases the cost of travelling, waste of time and other expenses. The assumption was that they rely on outdated sources of the information, midwifes with no professional medical experience. 3.3 Instruments The survey questionnaire was used as the main data-gathering instrument for this study (see Appendix I). The pre-test questionnaire was divided into three main sections: a profile, general mobile device information and the survey proper. The profile contains socio-demographic characteristics of the respondents such as age, education level, employment status, place of residence. The mobile device section has general information of the mobile device, the mobile service provider and Internet access information. The survey proper explored the perceptions of the maternal health-care access challenges, particularly on how mobile applications can facilitate easy and reliable access of maternal health-care information to expectant women. The questionnaire proper section also contains questions that identify the advantages and disadvantages of using mobile application to provide access to maternal health-care information. The post-test questionnaire had only one section of survey proper. This questionnaire mainly aimed at finding out if accessing maternal healthcare information through mobile application is easier and timely than accessing the information from traditional sources. In this research, the access to maternal healthcare information through a mobile application (independent variable) was monitored alongside the dependent variables of safe motherhood practices, mothers' awareness of pregnancy complications, infant and maternal mortality causes. Data gathered from this research instrument were then computed for interpretation. Along with primary data, the researcher also made use of secondary resources in the form of published articles and literature's to support the survey results. The questions were structured using the Likert format. In the Likert survey type, five choices are provided for every question or statement. The choice represents the degree of agreement each 16
27 respondent has on the given question. The scale below was used to interpret the total responses of all the respondents for every survey question by computing the weighted mean: Range Interpretation Strongly Agree Agree Neutral Disagree Strongly Disagree Table 3.1: Likert Scale Questionnaire of Agreement The Likert survey was the selected questionnaire type as this enabled the respondents to answer the survey easily. In addition, this research instrument allowed the researcher to carry out the quantitative approach effectively with the use of statistics for data interpretation. In order to test the validity of the questionnaire used for the study, the researcher tested both questionnaires with five respondents. These respondents as well as their answers were not part of the actual study process and were only used for testing purposes. After the questions were answered, the researcher asked the respondents for any suggestions or any necessary corrections to ensure further improvement and validity of the instrument. The researcher revised the survey questionnaires based on the suggestions of the respondents. The researcher then excluded irrelevant questions and changed vague or difficult terminologies into simpler ones in order to ensure comprehension. 3.4 Data Processing and Analysis After gathering all the completed questionnaires from the respondents, total responses for each item were obtained and tabulated. In order to use the Likert Scale for interpretation, weighted mean to represent each question was computed. Weighted mean is the average where every quantity to be average has a corresponding weight. These weights represent the significance of each quantity to the average. To compute for the weighted mean, each value must be multiplied by its weight. Products should then be added to obtain the total value. The total weight should also be computed by adding all weights. The total value is then divided by the total weight. Statistically, the weighted mean is calculated using the following formula: Weighted = S wx, where x = the data values and w = relative weight assigned to each observation, expressed as a percentage or relative frequency. 17
28 4.0 Overview of this Chapter Chapter 4 Data Analysis and Interpretation In this chapter, the data gathered from the sample group in relation to the research objectives is analyzed and interpreted. This chapter discusses the result of the pre-test and post-test questionnaires responded to by the 15 selected participants. Before the initiation of the pre-test research questionnaire, the significance, rationale and purpose of the study were provided to the respondents. Furthermore, the respondents were given the assurance that all the data they will give are used for the purpose of the research and their identities will be confidential. The object in the pre-test questionnaire was to determine the challenges facing the users in accessing maternal care information and if use of mobile technology to provide this information can solve the problem. The post-test questionnaire aims to establish how expectant women compare mobile application and other sources of maternal information in terms of easy of access, cost of access, easy of understanding, timely access. This is the manner unto which the research study accounts the factors and the perception on the criteria themselves. The conduct of the pre-test questionnaire entails a detailed account of the demographic profile of the respondents. It is assumed that the attributes of the respondents influence their behaviour and answers on the survey questions. Of particular significance to the achievement of the goals and objectives of the study is to be able to answer the research questions. 4.1 Pre-test Questionnaire Part 1: Profile The profile of the respondents is looked upon in terms of age, place of residence, educational attainment and employment status Age of the Respondents Figure 4.2 below shows the age range of the respondents. Fifty eight percent (58%) of the respondents were years old, showing that most of them were already considered as young 18
29 adults. Six percent (6%) of the respondents were between years old. Lastly, there is thirty six percent (36%) of respondents who are in the ages between years old. The apparent diversity of the maturity of the respondents reflects several implications in the study's findings. In relation of the age bracket of the respondents, the researcher could presume that in the said percentage, a considerable number could be among the young adult members of the population. This population group is active in adopting use of mobile phones. Age Figure 4.2: Age Range of the Respondents Place of Residence of the Respondents The intent of this question was to get the number of respondents who live in rural areas, slum areas and middle class/ high class areas. From the responses, 25% live in rural areas, 40% live in slum areas while the remaining 35% live in middle class / high class areas. Based on figure 4.3 below, the dominated area of residence is the slum areas. This shows that there are mostly expectant women in slum areas who have interest in participating in this research study due to the situation currently. 19
30 Residence Area Rural Slum Middle Class & High Class Figure 4.3: Residence Place of the Respondents Employment Status Figure 4.4 below shows the employment status of the respondents. 47% of the total respondents, which is the dominated response is employed. 30% of the respondents are self-employed. There is only 23% who are unemployed and house wives from the fifteen respondents. As the figure was interpreted, there is a little percentage of unemployed respondents. Employment Status Employed Self - Employed Unemployed Figure 4.4: Employment Status of the Respondents 20
31 Educational Attainment of the Respondents Likewise, the respondents were asked for their educational attainment and the report shows thirty three 33% of them are graduates. The survey indicates that most of the respondents are high school graduates at forty nine 49%. Eighteen percent 18% are primary school graduates. Figure 4.5 below shows that majority of the respondents are literate. Education Level Primary School High School Graduate Figure 4.5: Education level of the Respondents Mobile Phone Model of the Respondents The collected data showed a wide range of mobile phone models from various major manufacturers. Phone Manufacturer Respondents Percentage (%) Nokia % Samsung % Huawei Ideos % Ericsson 1 6.7% TOTAL % Table 4.2 : Types of Mobile Phones Owned by the Respondents The Nokia mobile phones had the highest percentage (53.3%) of mobile phone models owned by the respondents. This means that half of the respondents owned Nokia mobile phones. Samsung mobile phones were the second popular among the respondents, with 26.7% of the total number of respondents. Huawei Ideos was third with 13.3% while Sony Ericsson was the least owned by the population with 6.7%. 21
32 The collected data shows that if the mobile healthcare applications could be optimized for the Nokia mobile phones, a larger number of people would benefit, than having it optimized for another mobile manufacturer s devices Data Capability of the Mobile Phone Among the mobile phones owned by the respondents, thirteen (86.7%) of them had data capability meaning they can access Internet, while two respondents (13.3%) did not have data capability. Figure 4.6 below shows the distribution of the respondents mobile phones, based on the data capability of their mobile devices. Mobile Phone Data Data Enabled Non Data Enabled Figure 4.6: Respondents Mobile Phone Data Capability This shows that 86.7% of the respondents are able to work with mobile healthcare applications that require data capability, while 13.3% will require other means of mobile healthcare information provision like IVR, SMS, and USSD Mobile Phone Technology Among the mobile phones owned by the respondents, 67% of them were Java enabled while 33% were not. This means that a substantial number of the respondents would benefit from a J2ME mobile application, while a number of them will not be able to operate such an application on their mobile applications. In conclusion, there is need to build the applications based on other technologies e.g. Android to accommodate respondents whose phones are data enabled but not Java enabled. Figure 4.7 shows the mobile technology of the mobile phones owned by the respondents. 22
33 Mobile Technology Java Android Figure 4.7: Mobile Technology of the Respondents' Mobile Phones Respondents Experience with Mobile Applications The adoption and usage of a mobile health care application would be more successful if the target population has experience in using other mobile applications, e.g. games, social network applications, mobile banking and money transfer applications and other information oriented information, e.g. weather, dating or news. As per the collected data, 60% of the respondents had used another mobile application. Figure 4.8 shows the distribution of respondents based on their experience with mobile applications. Mobile Applications Experience Yes No Figure 4.8: Experience of Respondents with Mobile Applications This implies that the deployment of a mobile healthcare application among the respondents will have a positive reception. Also, because of their experience with other mobile applications, training them to use a mobile healthcare application will not be an uphill task. 23
34 Mobile Service Provider Distribution The successful deployment and adoption of a mobile application also depends on the mobile service provider, because of considerations such as data capability and the cost of sending and receiving information in the network. Table 4.3 shows the distribution of the respondents among the local mobile service providers. Service Provider Respondents Percentage (%) Safaricom % Airtel 1 6.7% Orange 0 0.0% Yu 1 6.7% TOTAL % Table 4.3: Mobile Service Provider among the Recipients According to the table above, Safaricom had the highest number of respondents, composing 86.6% of the total recipients. Airtel and Yu Mobile shared the 2 remaining respondents while no respondent used Orange. The table above implies that if the mobile application was designed targeting Safaricom mobile service provider, more users would experience better performance and cost effectiveness of the application on their mobile phones Mobile Healthcare Applications Usage The popularity of mobile healthcare applications was low among the respondents, with only 15% reporting that they had ever used a mobile healthcare application. Consequently, 85% of the respondents had never used any mobile healthcare application. This implies that the popularity of mobile healthcare applications is low as compared to the respondents experience with other mobile applications. 24
35 Mobile Healthcare Applications Usage Using Not Using Figure 4.9: Mobile healthcare applications usage Despite the fact that exposure of mobile healthcare applications to the respondents is low as shown in Figure 4.9, majority of the respondents were already using their mobile phones and the Internet to gain information on maternal healthcare as well as communicate to their doctors and physicians. Analysis of the respondents showed that they have been using their mobile phones to get information for the following maternal healthcare related services; general maternal healthcare information, lifestyles during the expectancy period, what foods to eat, clothes wear and which exercises to do during the expectancy period. They also communicate with doctors, paediatrics and other specialists. Respondents also collaborate with other expectant women, share experiences over the Internet using mobile phones and personal computers (PCs). The respondents went a step further and gave suggestions on how they would like to use their mobile phones to enhance their access to maternal health care information. These include periodic SMS reminders, directory listing all health care centres and hospitals around the respondents; booking appointments, scheduling and inviting friends for events like baby shower and more. The response concerning the usage of mobile phone in maternal healthcare showed that the respondents understood that they can use mobile phones to transform their expectancy period experience. Also, the numerous ideas given by the respondents on how they can use mobile applications to access maternal healthcare and more other related services formed the basis and motivation of the design of a mobile healthcare application Part II: Descriptive Analysis of the Questionnaire Responses This section provides the discussion and analysis of the perception of respondents based on the 25
36 weighted mean calculated from the collected data. Below is a table with the calculated weighted mean of all the questions and the responses. Question Number Weighted Mean Interpretation Neutral Neutral Disagree Neutral Neutral Agree Neutral Agree Agree Disagree Neutral Disagree Agree Neutral Neutral Table 4.4: Weighted Mean of the Responses Question 1: Overall I am satisfied how I access maternal information As shown in Figure 4.10, the respondents agree that they are quite satisfied with how they access maternal information. Respondents whose education level is secondary school and graduate agreed strongly in this question. This implies that education level plays a major role in understanding maternal healthcare information and those expectant women whose literacy level is low need to get an easier way to access this information. The researcher suggests use of vernacular language and Swahili language in delivering this information to them, preferably in as SMS. 26
37 Question 1 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.10: Question Question 2: I have access to up-to date maternal information Though many respondents agree to have access to maternal healthcare information, only a substantial number have access to up-to date maternal information. This is primarily due to the lack of a central updated database. Users get maternal information from sources that are not updated frequently, some not from certified sources. A maternal healthcare mobile application that provides easy and fast access to maternal healthcare information will alleviate the problem that many users have especially those in rural areas. Question 2 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.11: Question Question 3: I am confident to deal with any pregnancy complication that may arise Pregnancy complications are a nightmare to any expectant woman, but access to the right maternal care information can help them take preventive measures against these complications and if they occur, women have the information or where to get it. The respondents agreed that they are not fully confident to deal with the pregnancy complications that may occur during that period. 27
38 Question 3 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.12: Question Question 4: I am able to fully understand all the maternal information I receive Getting the maternal information is one part but understanding it is the major part. From the data analysis of the respondents, majority agreed that they understand the maternal information they receive. The only barrier is access to updated maternal healthcare information that can be solved by a mobile application that provides updated information and access all times from any place anytime. Question 4 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.13: Question Question 5: I have easy access to doctors, pre-natal and post-natal information care Access to doctors and pre-natal clinics is majorly dependent on the area of residence of the respondents. Those in rural areas had little access to doctors and these clinics since they are far and transport means are not reliable. Respondents in urban areas: slum areas, middle and high income areas easy access to doctors and pre-natal clinics. The only barrier is sometimes the cost that they have to pay for doctor s consultancy and fee. 28
39 Question 5 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.14: Question Question 6: I know where to get any maternal care information and assistance in time Majority of the respondents strongly agreed that they know where to get maternal healthcare information. The challenge was how to access this information since costs are incurred in some cases. Also, updated versions of the information are also hard to find in cases where the information is not indexed. Question 6 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.15: Question Question 7: It is difficult to get answers on any questions I have regarding pregnancy During expectancy period, women have a lot of questions that can be answered by the relevant, updated maternal information accessed easily and in time. The respondents agree that it is not that easy to get all answers for the questions they have regarding pregnancy. A maternal healthcare application that has blog functionality will enable users can ask, share and contribute on all questions, and seek clarification on pregnancy issues that they don t understand. 29
40 Question 7 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.16: Question Question 8: If you know the proper maternal information, it is possible to avoid pregnancy complications The respondents strongly agree that with access to maternal healthcare information, it is possible to avoid pregnancy complications. This would greatly reduce cases of infant deaths and maternal deaths. Question 8 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.17: Question Question 9: Mobile phone use makes it easy to access maternal information Having used the mobile phones for other data services, the respondents strongly agreed that mobile phones make it easy to access maternal health care information. Expectant women will have no problem in using a mobile application to access maternal healthcare information. 30
41 Question 9 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.18: Question Question 10: Doctors and health workers do not really give all the maternal information when Respondents indicated that doctors and health workers fail to deliver all information due to barriers like language, or talk on this sensitive matter makes them uneasy. Question 10 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.19: Question Question 11: It is expensive to access maternal healthcare information currently The cost of accessing maternal healthcare information is currently expensive especially to expectant women in the rural areas as indicated by the users who disagree in Figure 4.11 below. Respondents in urban areas disagree with this though because they can get the information easily within their reach. 31
42 Question 11 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.20: Question Question 12: I frequently use my mobile phone to access the Internet Majority of the respondents agreed that they use their mobile phones to access the Internet for social networking purposes, mobile banking, and more as shown in Figure This shows that the respondents will have no problems in using a mobile application to access maternal information. Question 12 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.21: Question Question 13: I would prefer to access maternal information via my mobile phone In Figure 4.22, majority of the respondents agreed that they are willing to receive maternal information through their mobile phones. 32
43 Question 13 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.22: Question Question 14: I always practice what I learn from the maternal information Respondents indicated that they practice what they learn from the maternal information exercises, diets and more as shown in Figure More detailed information can be provided to them as they progress in the pregnancy period. Question 14 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 23: Question Question 15: its difficult to trust some sources of maternal information Some sources of maternal information are difficult to understand or the respondents find them difficult to understand as indicated in their responses in Figure
44 Question 15 Strongly Disagree Disagree Neutral Agree Strongly Agree Figure 4.24: Question Post-test Questionnaire Analysis After the participants completed the pre-test questionnaire, LEA mobile application was installed in their mobile phones and they were given two weeks to test and use it. After the two weeks, the participants filled in the post test questionnaire Level of Satisfaction in Using Mobile Application for Maternal Information Access After testing LEA maternal healthcare application, 90% of the women were satisfied by using a mobile application to access maternal information as shown in Figure They described the application as a convenient source of information, a companion during the pregnancy period since they can access it anytime anywhere they need to know something or to ask, share or contribute something to the blog. The 10% unsatisfied with LEA mobile application indicated that they are new to using mobile application and need more training to understand how to use it. Others were unwilling to change since they trusted doctors because of the personal interaction and other sources and did not believe the information on mobile application was true. Satisfied Unsatisfied 34
45 Figure 4.25: Level of Satisfaction in Using Mobile Application To all participants, LEA acted as a support by providing general information for pregnancy and baby birth, making them more confident to deal with any complications that may arise during pregnancy. Its worth mentioning that expectant women can anticipate what will happen during the whole pregnancy period, including information about emerging risks to which women are frequently exposed and remind women of the need for preventive care Preferred Language of the Information Though 93% participants understood the information well in English, some of them wanted it in Swahili language and possibly translated to their vernacular languages. This way they can easily read and understand the information. Figure 4.26 below represents the mobile application users with their preferred languages Prefer English Prefer Other Language Figure 4.26: Preferred Language Cost of Accessing Maternal Healthcare information Using Mobile Application. In Figure 4.27 below, 87% of the respondents were of the opinion that cost of accessing maternal healthcare information through the mobile was cheap. This is highly attributed to the lowering of data costs by mobile providers due to stiff competition. Users can even redeem their loyalty points for free browsing. The remaining 13% maintained that the cost of data is still high due to slow connection speeds by some mobile subscribers and some require subscription of a certain amount. In some cases a user cannot purchase data bundles, unless the user has airtime on phone. 35
46 Cost is low Cost still high Figure 4.27: Cost of Data Access The participants whose mobile phones have access to Internet did not prefer calling and listening to the information. The participants whose mobile phones cannot connect to the Internet used the IVR functionality of the application to dial and listen to the information. Majority of the respondents proposed the use of SMS for periodic alerts, reminders. This will have reach to all users despite the mobile phone they have Preferred Source of Maternal Healthcare Information Figure 4.28 is a comparison of mobile application to traditional sources of maternal information. 95% of the participants greatly appreciated that mobile applications provided timely pregnancy advice unlike other sources of this information like books, doctors who are not always within ones reach every time. Mobile Application Traditional Sources Figure 4.28: Preferred Source of Maternal Information 36
47 Chapter 5 Design and Implementation 5.0 Architecture of the Proposed Mobile Application The researcher developed a mobile application called LEA using the client-server architecture. LEA is a Swahili name for nurture. The client-server model is a computing model that acts as distributed application which partitions tasks or workloads between the providers of a resource or service, called servers, and service requesters, called clients. In this mobile application the clients are the mobile devices that the users have while the server resides on other hardware. The server hosts the maternal healthcare information. When a user is accessing the maternal information, a request is sent via the internet to the server. The server fetches the specific maternal information that the user needs and displays it to the user. If the client cannot connect to the server due to lack of Internet connection, an error message is displayed. This model is demonstrated in Figure 5.29 below. The clients in this case are mobile phones. Source: Wikipedia Figure 29: Client-Server Architecture Model This client-server model was chosen since the mobile phone has memory constraints on the size of information that can be stored on the phone. The information is stored on the server side; hence the memory on the client side is reserved for processing. Two, this model makes the mobile application dynamic in that the information can be updated anytime without affecting the client side. This enables the researcher to provide the relevant information to the users easily. The client-server model acts as a distributed computing platform where many clients can access one resource leading to more productivity and providing several points of access. 37
48 LEA mobile application client side is downloadable to mobile phone while the backend is managed from a website by an administrator from a PC. It was developed on Java NetBeans platform and PHP. 5.1 Development In the System Analysis and Design phase of LEA mobile application, the Object Oriented Analysis and Design (OOAD) was used since it has the benefits of Reuse of classes and code improving system quality and robustness. With reuse, a developer only needs to connect the right classes giving industrial strength applications that run correctly the first time, allowing for extension, robustness, avoiding over cost projects, late project deliveries and error free development. Data analysis was done using Unified Modelling Language (UML) to understand the domain of the system. Figure 5.30 is LEA Use Case Diagram showing the interactions between actors and modules of the mobile application. 38
49 LEA USE CASE DIAGRAM register * * login * view information * * * ** * * * ask & contribute blog baby due date calc * * * * * ** * User Listen to Info - IVR * * manage information * Administrator manage users * manage blog * manage advertisements * * manage IVR Figure 30: LEA Use Case Diagram The high level data flow diagram in Figure 5.31 explains the process model of the system. 39
50 LEA DATA FLOW DIAGRAM User Enter details 1.0 Register Save user details D1 Users Details Confirm registration Input User Information Ask/contribute in blog D3 Blog details Retrieve information Get maternal information 2.0 FMI 3.0 Blog Blogs & comments Delete D2 FMI View all maternal information Push adverts Join best mommy community 4.0 Maintenance Disable Push adverts Delete Blogs Push adverts Delete D4 Advertisements 7.0 Maintenance Input ads Run Adverts 5.0 Maintenance Get ads Get blog threads Delete Adverts 6.0 Maintenance Get adverts Admin Get users Disable users 5.2 Implementation System Implementation Figure 5.31: Architecture of LEA Mobile Application During implementation the necessary programs for LEA were coded, debugged and documented. Testing the application during development was done using both S40 and S60 mobile phones. 40
51 5.2.2 System Specification Due to the constraints a mobile device faces, few packages were used as many packages would cause memory problems. The compatibility of LEA between different mobile devices operating systems was a major concern and tests were done with a variety of mobile phones, especially those the questionnaire respondents had Development Environment Software Tools used i. Software: Net beans ii. Language: PHP iii. Web Server: MySql. iv. Database: SQL Server. v. IVR: XML hosted by Voxeo in US. The system is developed in J2ME for the client side, PHP for the server side and the central database is based on SQL Server. The Interactive Voice Response is developed in XML Client Environment A J2ME enabled mobile device with minimum free space of about 600KB. The mobile device should also be data enabled to initiate download of the application and connect to the server to retrieve information when using the application. Required is any mobile device to test the IVR functionality, since the IVR does not need any special requirements, just a mobile phone that has airtime. 5.3 Walk Through the Whole Mobile Application System First, a user has to initiate a download the mobile application using (Over the Air) OTA method and install the application on his phone. A first time user will be prompted to register with her details in 41
52 the application. These details are required for blogging purposes. The main menu in Table 5.5 is the landing page with the functionalities of LEA. Free Maternal Information Blog Baby Due Date calculator Listen to Information Setup & Maintenance Provides the link to the categorized information Prompts user to login / register and links to the start blog or contribute to existing blogs Opens the calculator and prompts the user to select the last date of menstruation and then calculates the baby due date. Prompts user do dial the number and listen to the information Links to the Administrator section and reports generation section via URL. This link is only available to users who are designated as System Administrators and is web based Table 5.5: Main Menu of LEA Mobile Application Free Maternal Information The main menu has the free maternal information as the initial tab. This opens the categories available for the information. The user can click on any category and read on maternal information for free. The main menu form, categories form and information form are shown below respectively How LEA IVR Works This functionality enables users to dial and listen to the information through an Interactive Voice Response mechanism. The user navigates through the categories by pressing keys on the mobile phone keypad as directed by the voice prompts. Table 6 is a description of how LEA IVR works. 42
53 Dial the LEA IVR Then Press Key Then Listen Telephone Number: Press the category number on your mobile phone keypad. Listen to the information under the category number you pressed. After the information is over you are prompted to press another category or exit. If you didn t press any key within 5 seconds, you are prompted again to select category. If you press key for a category that does not exist e.g. 0 or 9, an error message is read to you. Table 5.6: LEA IVR Description Blog Navigating through the main menu gives the blog tab. This functionality enables users to ask, share and contribute to maternal issues, pregnancy complications and more. The user is prompted to register if new or login if already registered. Once the user is logged in, access to the blog is granted Baby Due Date Calculator This functionality opens the calendar and prompts the user to select the last date of menstruation. The baby due date is calculated using the LMP method. 43
54 Below is a detailed description of how LEA mobile application works and is managed. i. The splash screen displays adverts as the app loads ii. iii. iv. The main menu Categories of Information Free Information Centre v. Register to Blog vi. vii. viii. ix. Login to Blog Blog Centre Calendar to Pick last menstruation date Baby Due Date Calendar x. Dial and Listen 44
55 Figure 5.30: Splash Screen Figure 5.31: Main Menu When the user launches the application, the splash screen in Figure 5.30 above is displayed as the application loads. The main menu in Figure 5.31 is the landing page with the functionalities that provide access to the maternal healthcare information. 45
56 Figure 5.32: Information Catégories Figure 5.33: Information Centre The maternal information is provided in 8 categories as shown in Figure These are; pregnancy signs, trimesters, giving birth, baby care centre, things to avoid, and things to do during pregnancy, pregnancy complications, what to eat and wear during pregnancy. These categories open links to the information centre which has detailed information regarding pregnancy. A sample of information in the category of pregnancy signs is shown in Figure
Accessing Maternal Healthcare Information Using A Mobile Application
Strathmore University RA971.23.K562012 Accessing maternal healthcare information Accessing Maternal Healthcare Information Using A Mobile Application Shadrack Kioko Submitted in partial fulfilment to the
More informationMobile health: scaling the value chain
32 Linklaters / Generation Next: Five pathways to TMT growth in emerging markets / Mobile health Mobile health: scaling the value chain Mobile health is set to generate around $8.8bn of annual revenues
More informationMOBILE PHONE BASED PREGNANCY SUPPORT SYSTEM JAYANTHY MANIAM CHIN CHEE KEN KANAGA CHENAPIAH
MOBILE PHONE BASED PREGNANCY SUPPORT SYSTEM JAYANTHY MANIAM CHIN CHEE KEN KANAGA CHENAPIAH ICT R&D Centre, School of Computer Technology, Sunway University College ABSTRACT Being pregnant can be very challenging
More informationImplementing Mobile Health Programs
Implementing Mobile Health Programs By William Tella, President and Chief Executive Officer, GenerationOne Over a period of just 10 years, people across the globe have changed the basic nature of their
More informationFIGHTING AGAINST MATERNAL AND NEONATAL MORTALITY IN DEVELOPING COUNTRIES
PRESS KIT February 2014 FIGHTING AGAINST MATERNAL AND NEONATAL MORTALITY IN DEVELOPING COUNTRIES WIVES ID M G IN T C E CONN CONTENT 02 Key figures 03 Launch of the international "Connecting Midwives" web
More informationGirls education the facts
Education for All Global Monitoring Report Fact Sheet October 2013 Girls education the facts Millions of girls around the world are still being denied an education PRIMARY SCHOOL: There are still 31 million
More informationThe Role of International Law in Reducing Maternal Mortality
The Role of International Law in Reducing Maternal Mortality K. Madison Burnett * Safe motherhood is a human rights issue The death of a woman during pregnancy or childbirth is not only a health issue
More informationWorld Health Day Diabetes and RMNCAH in Africa: R for Reproductive Health
World Health Day Diabetes and RMNCAH in Africa: R for Reproductive Health Managing diabetes and reproductive health in developing contexts. The 2016 World Health Day theme to scale up prevention, strengthen
More informationTELEMEDICINE IN DEVELOPING COUNTRIES. Norm Archer, Ph.D. Information Systems Dept. and ehealth Program McMaster University
TELEMEDICINE IN DEVELOPING COUNTRIES Norm Archer, Ph.D. Information Systems Dept. and ehealth Program McMaster University INTRODUCTION Telemedicine in developing countries is a tool of Global Health Global
More informationCommunications for change:
Communications for change: How to use text messaging as an effective behavior change campaigning tool Produced by FrontlineSMS and Text to Change COMMUNICATIONS FOR CHANGE Introduction SMS can be an extremely
More informationcambodia Maternal, Newborn AND Child Health and Nutrition
cambodia Maternal, Newborn AND Child Health and Nutrition situation Between 2000 and 2010, Cambodia has made significant progress in improving the health of its children. The infant mortality rate has
More informationLEARNING CASE 9: GENDER AND RURAL INFORMATION AND COMMUNICATIONS TECHNOLOGY 1
LEARNING CASE 9: GENDER AND RURAL INFORMATION AND COMMUNICATIONS TECHNOLOGY 1 1. An Information and Communications Technology (ICT) project in Jordan was launched to create an enabling environment that:
More informationInnovative Mobile Technologies improving health in developing countries. Professor Kristin Braa Department of Informatics University of Oslo
Innovative Mobile Technologies improving health in developing countries Professor Kristin Braa Department of Informatics University of Oslo The importance of mobile technology for developing countries
More informationImpact study 2015-2016
Impact study 2015-2016 Contents TTC Mobile at a glance 2 Impact value chain 3 Research goals and process 4 Data collection overview 5 Research results: impact on clients 6 Research results: impact on end-users
More informationAmish Midwifery Care Program
April 2012 Page 1 of 5 Grant Outcomes Report An Amish Midwifery Care Program in Chautauqua County The Problem: KEY INFORMATION: GRantEe Westfield Memorial Hospital, Inc. grant title Amish Midwifery Care
More informationHealthcare IT Assessment Model
Healthcare IT Assessment Model Evaluating Technology-Supported Healthcare Programs in Developing Nations White Paper Healthcare IT Assessment Model A practical framework from Intel helps governments and
More informationMobile for Development - Reaching the Unreached
Mobile for Development - Reaching the Unreached www.m4dev.org Mobile for Development (M4D) is a technology initiative to create practical and sustainable mobile solutions & services to enable social development
More informationmwomen Innovation Grants Updated June 2014
mwomen Innovation Grants Updated June 2014 mwomen Innovation Grants: Map GSMA mwomen have awarded 11 grants to MNOs and NGOs with Vodafone Foundation with Robi with Airtel with Airtel Countries awarded
More informationMobile Technology for Community Health Project
Mobile Technology for Community Health Project SolDevelo s Case Study and Project Information What is MOTECH The Mobile Technology for Community Health (MOTECH) Platform is an open source software project
More informationEducation is the key to lasting development
Education is the key to lasting development As world leaders prepare to meet in New York later this month to discuss progress on the Millennium Development Goals, UNESCO s Education for All Global Monitoring
More informationMedical Management Plan Togo
Medical Management Plan Togo OVERVIEW Company Mission Our mission is to encourage young people to volunteer for worthwhile work in developing countries. We expect that doing this kind of voluntary work
More informationIFMSA Policy Statement Human Resources for Health
IFMSA Policy Statement Human Resources for Health Location: Taipei, Taiwan. Date of Adoption: August 9 th 2014. Date of Expiry: August 9 th 2017. Summary We, the International Federation of Medical Students
More informationShutterstock TACstock
Shutterstock TACstock 10 Introduction Since 2000, the IDF Diabetes Atlas has detailed the extent of diabetes and this seventh edition shows how it is impacting every country, every age group and every
More informationSouth African Nursing Council (Under the provisions of the Nursing Act, 2005)
South African Nursing Council (Under the provisions of the Nursing Act, 2005) e-mail: registrar@sanc.co.za web: www.sanc.co.za P O Box 1123, Pretoria, 0001 Republic of South Africa Tel: 012 420-1000 Fax:
More information117 4,904,773 -67-4.7 -5.5 -3.9. making progress
Per 1 LB Eastern Mediterranean Region Maternal and Perinatal Health Profile Department of Maternal, Newborn, Child and Adolescent Health (MCA/WHO) Demographics and Information System Health status indicators
More information150 7,114,974 75.8 -53-3.2 -3.6 -2.9. making progress
Per 1 LB African Region Maternal and Perinatal Health Profile Department of Maternal, Newborn, Child and Adolescent Health (MCA/WHO) Demographics and Information System Health status indicators - Maternal
More informationAdoption of Information Technology in Healthcare: Benefits & Constraints
Adoption of Information Technology in Healthcare: Benefits & Constraints A WiredFox Technologies White Paper 2 Adoption of Information Technology in Healthcare: Benefits & Constraints By Jeff Yelton 3
More informationm-health definition J son & Partners [registered trade mark]. 1
J son & Partners Consulting company presents the main results of the research: m-health market in Russia and worldwide: main tendencies and forecasts. Main goal is to analyze m-health market and to define
More informationSecured Health Information Network and Exchange (SHINE)
Secured Health Information Network and Exchange (SHINE) FOR INTERNAL USE ONLY. NOT FOR EXTERNAL DISTRIBUTION. Page 1 Outline Overview SMART and Partners The SHINE Service Technologies Employed Innovative
More informationEffective System for Pregnant Women using Mobile GIS
Effective System for Pregnant Women using Mobile GIS Ayad Ghany Ismaeel Department of Information System Engineering- Erbil Technical College- Hawler Polytechnic University (previous FTE- Erbil), Iraq.
More informationSince achieving independence from Great Britain in 1963, Kenya has worked to improve its healthcare system.
Medical Management Plan Kenya OVERVIEW Company Mission Our mission is to encourage young people to volunteer for worthwhile work in developing countries. We expect that doing this kind of voluntary work
More informationTowards the Future. Global Health: Women and Children first
Towards the Future Global Health: Women and Children first Problems and needs The year 2015 will be a turning point for the fight against poverty at a global level. The dates for the millennium goals
More information68 3,676,893 86.7 -49-2.9 -3.2 -2.5. making progress
Per 1 LB African Region Maternal and Perinatal Health Profile Department of Maternal, Newborn, Child and Adolescent Health (MCA/WHO) Demographics and Information System Health status indicators Maternal
More informationGLOBAL GRANT MONITORING AND EVALUATION PLAN SUPPLEMENT
ENGLISH (EN) GLOBAL GRANT MONITORING AND EVALUATION PLAN SUPPLEMENT Global grant sponsors for humanitarian projects and vocational training teams must incorporate monitoring and evaluation measures within
More informationThis is a licensed product of Ken Research and should not be copied
1 TABLE OF CONTENTS 1. Global Telemedicine Market Introduction 2. Global Telemedicine Market Size, 2006-2013 3. Global Telemedicine Market Segmentation 3.1. By Telehome and Telehospital, 2006-2013 4. The
More informationPrescription for Life:
Prescription for Life: Take action to help children living with HIV The vast majority of children living with HIV around the world lack access to HIV testing and treatment. We can do something about that.
More information30% Opening Prayer. Introduction. About 85% of women give birth at home with untrained attendants; the number is much higher in rural areas.
This is the second of four studies on maternal health M AT E R N A L a n d C H I L D H E A LT H : A f g h a n i s t a n b y K a r e n B o k m a About 85% of women give birth at home with untrained attendants;
More informationPutting information at the heart of nursing care. How IT is set to revolutionise health care and the NHS
Putting information at the heart of nursing care How IT is set to revolutionise health care and the NHS Introduction Welcome to the 21st century! Information technology (IT) has become part of our everyday
More informationPROPOSAL. Proposal Name: Open Source software for improving Mother and Child Health Services in Pakistan". WHO- Pakistan, Health Information Cell.
PROPOSAL Proposal Name: Open Source software for improving Mother and Child Health Services in Pakistan". Submitted by: WHO- Pakistan, Health Information Cell. Please provide a description of the proposal
More informationTerms of Reference: Consultant Firm Business Plan for regional Mobile Applications Laboratories
Terms of Reference: Consultant Firm Business Plan for regional Mobile Applications Laboratories infodev, a donor funded agency hosted by the World Bank, intends to invite a consultant firm to help in developing
More informationFor more information, please visit anthem.com/ca.
For more information, please visit anthem.com/ca. SpecialOffers is provided by Anthem Blue Cross as a service to our members. These services do not constitute benefits under Anthem Blue Cross plans and
More informationBUSINESS PROPOSAL. CliGO SMS APPLICATION AFIDAY 23RD JULY, 2012
BUSINESS PROPOSAL ON CliGO SMS APPLICATION BY AFIDAY 23RD JULY, 2012 Table of Contents 1.0 Executive Summary... 1-3 2.0 Market Analysis 4-5 2.1 Market Size... 4 2.2 Problem Identification... 4 3.0 Team
More informationA Guide for Enrolling Patients and Clients in Text4baby. Harnessing the Power of Mobile for Maternal & Child Health in the U.S.
A Guide for Enrolling Patients and Clients in Text4baby Harnessing the Power of Mobile for Maternal & Child Health in the U.S. Text4baby Supports Patients Text4baby is the largest mobile health initiative
More informationReinventing Global Health Assistance and Interventions through Real-Time Online Collaboration
Collaborating, learning, and adapting (CLA) have long been a part of USAID s work. USAID staff and implementing partners have always sought ways to better understand the development process and USAID s
More informationEngaging mobile consumers in emerging markets
Engaging mobile consumers in emerging markets A connected world 4 Billion people are now online 1.3 billion live in the emerging markets Source: ITU November 2014 Q. How do you reach, understand and engage
More informationMaternal and Neonatal Health in Bangladesh
Maternal and Neonatal Health in Bangladesh KEY STATISTICS Basic data Maternal mortality ratio (deaths per 100,000 births) 320* Neonatal mortality rate (deaths per 1,000 births) 37 Births for women aged
More informationDEVELOPING WORLD HEALTH PARTNERSHIPS DIRECTORY
DEVELOPING WORLD HEALTH PARTNERSHIPS DIRECTORY OVER 250 HEALTH PARTNERSHIPS THAT MAKE A DIFFERENCE TO PEOPLE S LIVES The global health community needs to overcome both new and current challenges in the
More informationKANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT DIVISION OF PUBLIC HEALTH BUREAU OF FAMILY HEALTH
KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT DIVISION OF PUBLIC HEALTH BUREAU OF FAMILY HEALTH Teen Pregnancy Targeted Case Management Manual January 2016 1 TEEN PREGNANCY TARGETED CASE MANAGEMENT MANUAL
More informationIntegrated Healthcare Technology Package: Introduction. Peter Heimann World Health Organization, Genève
Integrated Healthcare Technology Package: Introduction Peter Heimann World Health Organization, Genève Why ihtp MILLENNIUM DEVELOPMENT GOALS T0 BE ACHIEVED BY 2015 1. Halve extreme poverty and hunger 2.
More informationThe contribution of nurses and midwives to global health
The contribution of nurses and midwives to global health Pat Hughes Consultant: Nursing, Health & Development C3 Collaborating for Health De Montfort University, 8 May 2015 Outline International Nurses
More informationHealthcare Delivery. Transforming. through Mobility Solutions. A Solution White Paper - version 1.0
Transforming Healthcare Delivery through Mobility Solutions A Solution White Paper - version 1.0 HTC Global Services HTC Towers, No. 41, GST Road, Guindy, Chennai - 600 032, India. Ph: +91 44 4345 3500
More informationNumber of consumer customers (Million) Market share (% consumer subscribers)
Customers Who are our customers? We are delighted to be able to report that we have grown to 23.4 million customers in total this year, which represents an increase of 8.3% from the previous year. Our
More informationTop Tips for Involving Fathers in Maternity Care
Compared with past generations, society s expectations are increasingly for fathers to play a full role throughout pregnancy, labour, childbirth and in the postnatal period. Most expectant mothers want
More informationGetting Started with iphone SDK, Android and others: Mobile Application Development Create your Mobile Applications Best Practices Guide
Getting Started with iphone SDK, Android and others: Mobile Application Development Create your Mobile Applications Best Practices Guide Copyright 2008 Mobile Application Development 100 Success Secrets
More informationNew Healthcare Vision
HEALTHCARE SOLUTIONS BRIEF New Healthcare Vision Collaborative video solutions improving care and reducing cost Collaboration face to face: the power of being there, without going there. Collaboration
More informationSocial Marketing and Breastfeeding
Global Journal of Management and Business Studies. ISSN 2248-9878 Volume 3, Number 3 (2013), pp. 303-308 Research India Publications http://www.ripublication.com/gjmbs.htm Social Marketing and Breastfeeding
More informationWritten contribution to the Committee on the Rights of the Child
Written contribution to the Committee on the Rights of the Child 2014 Day of General Discussion Digital Media and Children s Rights 12 September 2014 Breastfeeding protection, an essential component of
More informationUSING OPEN AND DISTANCE LEARNING FOR TEACHER PROFESSIONAL DEVELOPMENT IN THE CONTEXT OF EFA AND THE MDG GOALS: CASE OF THE PEDAGOGIC DRUM IN CAMEROON
USING OPEN AND DISTANCE LEARNING FOR TEACHER PROFESSIONAL DEVELOPMENT IN THE CONTEXT OF EFA AND THE MDG GOALS: CASE OF THE PEDAGOGIC DRUM IN CAMEROON Michael Nkwenti Ndongfack, Ministry of Basic Education,
More informationOne billion. Mobile Broadband subscriptions 2011. An Ericsson Consumer Insight Study on consumers connectivity needs
One billion Mobile Broadband subscriptions 2011 An Ericsson Consumer Insight Study on consumers connectivity needs This is ERICSSON CONSUMERLAB ConsumerLab is a knowledge-based organization. We provide
More informationRegional cover with a personalised touch Executive Healthcare Plan
Regional cover with a personalised touch Executive Healthcare Plan www.aetnainternational.com 66.02.919.1-MEA B (5/15) At Aetna, we make it our business to understand your business, as well as the unique
More informationIs the success of M-Pesa empowering Kenyan rural women?
156 Feminist Africa 18 Is the success of M-Pesa empowering Kenyan rural women? Oumy Khairy Ndiaye M-Pesa ( M for mobile, pesa is Swahili for money) is one of the most celebrated success stories in information
More informationProgress and prospects
Ending CHILD MARRIAGE Progress and prospects UNICEF/BANA213-182/Kiron The current situation Worldwide, more than 7 million women alive today were married before their 18th birthday. More than one in three
More informationHealth Care 2.0: How Technology is Transforming Health Care
Health Care 2.0: How Technology is Transforming Health Care Matthew Kaiser, CEBS, SPHR Director, HR Technology and Outsourcing Lockton Kansas City, Missouri The opinions expressed in this presentation
More informationChapter 13: Transition and Interagency Agreements
Healthy Start Standards & Guidelines 2007 Chapter 13: Transition and Interagency Agreements Introduction Transition is movement or change from one environment to another. Transition activities are a critical
More informationNovartis CardioEngagement Challenge
CHANGING MINDSETS WITH HANDSETS Novartis CardioEngagement Challenge The Sensei Team Robert Schwarzberg, MD founder & CEO Sensei, Inc Renée Melton, MS, RD, LD VP Wellness & Health Promotion, Sensei, Inc
More informationA Descriptive Study of Depression, Substance Abuse, and Intimate Partner Violence Among Pregnant Women
A Descriptive Study of Depression, Substance Abuse, and Intimate Partner Violence Among Pregnant Women 1 OVERVIEW This presentation is based on the study of pregnant women enrolled in the Augusta Partnership
More informationGENDER AND DEVELOPMENT. Uganda Case Study: Increasing Access to Maternal and Child Health Services. Transforming relationships to empower communities
GENDER AND DEVELOPMENT Uganda Case Study: Increasing Access to Maternal and Child Health Services The Context World Vision has been active in working with local communities to increase access to health
More informationhttp://english.gov.cn/laws/2005-08/24/content_25746.htm
Page 1 of 5 Measures for Implementation of the Law of the People's Republic of China on Maternal and Infant Care (Promulgated by Decree No.308 of the State Council of the People's Republic of China on
More informationAs of 2010, an estimated 61 million students of primary school age 9% of the world total - are out of school vi.
YOUTH AND EDUCATION HIGHLIGHTS 10.6% of the world s youth (15-24 years old) are non-literate i. Data from 2011 indicates that in developing countries, the percentage of non-literate youth is 12.1%, with
More informationIBM Brings Watson to Africa
IBM Brings Watson to Africa $100M Project Lucy Initiative Heralds New Era of Data-Driven Development LAGOS and NAIROBI - 06 Feb 2014: IBM (NYSE: IBM) has launched a 10- year initiative to bring Watson
More informationPromoting Family Planning
Promoting Family Planning INTRODUCTION Voluntary family planning has been widely adopted throughout the world. More than half of all couples in the developing world now use a modern method of contraception
More informationWHO Consultation on the Zero Draft Global Mental Health Action Plan 2013-2020 International Diabetes Federation (IDF) Submission
WHO Consultation on the Zero Draft Global Mental Health Action Plan 2013-2020 International Diabetes Federation (IDF) Submission The International Diabetes Federation (IDF), an umbrella organisation of
More informationMarketing Your Telehealth Program
Marketing Your Telehealth Program A White Paper Marketing Your Telehealth Program 1 Marketing Your Telehealth Program Many Telehealth networks were built on a premise that came from an old movie: If you
More informationIncome is the most common measure
Income Goal A healthy standard of living for all Income is the most common measure of socioeconomic status, and a strong predictor of the health of an individual or community. When assessing the health
More informationWHITE PAPER. M-Health: Challenges, benefits, and keys to successful implementation. Abstract
WHITE PAPER M-Health: Challenges, benefits, and keys to successful implementation Kaushal Modi and Radha Baran Mohanty Abstract The outlook towards healthcare has changed drastically in recent times. Mobile
More informationPRESENTATION OF PROPOSED MONITORING STRATEGY FOR NIGERIA
PRESENTATION OF PROPOSED MONITORING STRATEGY FOR NIGERIA BY DR ANTHONIA I ACHIKE TEAM LEADER, CBMS NIGERIA FEBRUARY, 2009. TABLE OF CONTENTS Revision of Key Points in Proposal Transmission Channels of
More information8th Medical Open Source Software Symposium
8th Medical Open Source Software Symposium openehr as A New Approach to Electronic Health Record System in Cambodia Maternity Care Program Kakada Hok 2009.10.31 1 Objectives of the Research Study To identify
More informationTRANSITIONAL DISTANCE THEORY AND COMMUNIMCATION IN ONLINE COURSES A CASE STUDY
TRANSITIONAL DISTANCE THEORY AND COMMUNIMCATION IN ONLINE COURSES A CASE STUDY Scott Mensch, Indiana University of Pennsylvania SMensch@IUP.edu Azad Ali, Indiana University of Pennsylvania Azad.Ali@IUP.edu
More informationMobile Apps at the Base of the Pyramid - South Africa
Mobile Apps at the Base of the Pyramid - South Africa Vodacom, Cape Town, 15 February 2013 1 Methodology 2 Nationally Representative Survey Survey Characteristics Target Population Domains Survey summary
More informationMedicaid Presumptive Eligibility Instructions for Providers September 2015
Medicaid Presumptive Eligibility Instructions for Providers September 2015 KC 3767 (R-7-15) 0 MEDICAID PRESUMPTIVE ELIGIBILITY PROGRAM OVERVIEW The Medicaid Presumptive Eligibility (MPE) program is one
More informationORGANIZATIONS. Organization Programmatic Areas of Focus Notes Interviewed? Yes. Averting Maternal Death and Disability (AMDD)
Averting Maternal Death and Disability (AMDD) Bixby Center for Global Reproductive Health (UCSF) Global advocacy, human rights, strengthening health systems (conducting needs assessments for EmOC, strengthening
More informationThe Seven Elements of Great Social Customer Service
The Seven Elements of Great Social Customer Service How to Win the Social Media Customer Service Challenge in The Contact Center As consumers turn in droves to social media to solve problems, share and
More informationCOMMUNITY HEALTH FORUMS FINAL REPORT. Summary of results from three community forums February through March, 2013
COMMUNITY HEALTH FORUMS FINAL REPORT Summary of results from three community forums February through March, 2013 CONVENER CHRISTUS St. Vincent Regional Medical Center FACILITATOR New Mexico First Copyright
More informationFact Sheet: Youth and Education
Fact Sheet: Youth and Education 11% of the world s youth (15-24 years old) are non-literate. Data from 2005-2008 indicates that in developing countries, the percentage of nonliterate youth is 13%, with
More informationCost- Effective Shipboard Video Chat
Cost- Effective Shipboard Video Chat Achieving maximum performance from minimum bandwidth The promise of ever greater quantities of bandwidth and airtime is re-shaping maritime communications, but the
More informationThe use and possibilities of m-applications in East Africa
The use and possibilities of m-applications in East Africa Discussion paper Johan Hellström UPGRAID johan@upgraid.org BACKGROUND This discussion paper is based on a forthcoming Sida-report on the use and
More informationInstitutional Reforms to Reduce the Cost of Medical Care. Chairman, the Cato Institute
Institutional Reforms to Reduce the Cost of Medical Care by William A. Niskanen Chairman, the Cato Institute presented at the 60 th anniversary meeting of the Mont Pelerin Society Tokyo, Japan 9 September
More informationAnnex 1 Cadre definitions used in the project
WHO recommendations OPTIMIZEMNH Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting Annex 1 Cadre definitions used in the project DEFINITIONS
More informationPutting information at the heart of nursing care
ehealth and nursing practice Putting information at the heart of nursing care How IT is revolutionising health care Introduction Information technology (IT) has become part of our everyday lives. We watch
More informationFrequently Asked Questions (FAQs)
Frequently Asked Questions (FAQs) Research Rationale 1. What does PrEP stand for? There is scientific evidence that antiretroviral (anti-hiv) medications may be able to play an important role in reducing
More informationStrengthening Integrated Education Programs for Blind and Visually Impaired Children in Bangladesh
WA 092 Strengthening Integrated Education Programs for Blind and Visually Impaired Children in Bangladesh Manju Samaddar Principal Baptist Sangha School for Blind Girls 77, Senpara Parbata, Mirpur 10 Dhaka
More informationFree healthcare services for pregnant and lactating women and young children in Sierra Leone
Free healthcare services for pregnant and lactating women and young children in Sierra Leone November 2009 Government of Sierra Leone Contents Foreword 3 Country situation 4 Vision 5 Approach 6 Focus 6
More informationAppeal to the Member States of the United Nations Early Childhood Development: The Foundation of Sustainable Human Development for 2015 and Beyond
UNICEF/NYHQ2006-0450/Pirozzi Appeal to the Member States of the United Nations Early Childhood Development: The Foundation of Sustainable Human Development for 2015 and Beyond We, the undersigned, submit
More informationAnnex 1 Cadre definitions used in the project
WHO recommendations OPTIMIZEMNH Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting Annex 1 Cadre definitions used in the project DEFINITIONS
More informationSubmission to Australian Government Productivity Commission Allison Slykerman 29.8.10
Submission to Australian Government Productivity Commission Allison Slykerman 29.8.10 1. Introduction My name is Allison Slykerman and I have practiced as a maternal and child health nurse in Victoria
More informationSUB-SAHARAN AFRICA ERICSSON MOBILITY REPORT
SUB-SAHARAN AFRICA ERICSSON MOBILITY REPORT NOVEMBER 2015 Market Overview Key figures: Sub-Saharan Africa 2015 2021 CAGR 2015 2021 Mobile subscriptions (million) 690 1,020 7% Smartphone subscriptions (million)
More informationPromoting the Sexual and Reproductive Rights and Health of Adolescents and Youth:
August 2011 About the Youth Health and Rights Coalition The Youth Health and Rights Coalition (YHRC) is comprised of advocates and implementers who, in collaboration with young people and adult allies,
More informationBORDERS BROADBAND - FREQUENTLY ASKED QUESTIONS
BORDERS BROADBAND - FREQUENTLY ASKED QUESTIONS What is this project about? Who is behind it? Why was this area chosen? How much will the project cost? Who will get improved broadband? When will it all
More informationEnterprise Broadband Access:
Enterprise Broadband Access: What s Your Choice? Executive Summary Today, broadband access isn t just about making a connection to the Internet; it s about running bandwidth-intensive business and multimedia
More informationCASE STUDY. Duma Works brings affordable hiring to MSMEs, sparking economic growth from the BoP
CASE STUDY Duma Works brings affordable hiring to MSMEs, sparking economic growth from the BoP OCTOBER 2014 CONTENTS INTRODUCTION Key Findings COUNTRY CONTEXT Kenya Mobile Market Service Overview Market
More information